Summary Report for FSPSAs Ending During the Report Period Center: 05
This report shows the total number of units/fees for FSPSAs ending during the report period.
(i.e., end date of service authorization occurs during the report period). This report does not
represent all FSPSAs that overlap the report period. Note that service authorization periods may
range from 1 to 12 months and may vary in intensity from child to child.
FSPSAs ending between: 10-01-21 and 12-31-21 Date of Report: 02-04-22 Page: 1
Eligibility Filter: Program Patients
With the filters selected there were 1248 FSPSA's found
Services Cpt Code Number of Number of Total Units Total Cost of Avg Fee
Children Records Authorized Auth Services Per Unit Auth
Service Coordination, Class # 01
SCONLY-SCONLY *SERVICE COORDINATION ONLY 17 17 20.088889 $0.0000 $0.0000
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Subtotal (Total Children Is Unduplicated) 17 17 20.088889 $0.0000 $0.0000
Screening, Eval, and Assessment, Class # 02
EXIT -EXIT EXIT ASSESSMENT 1 1 2.000000 $100.0000 $50.0000
IPDEF -T1024GNTS F/U PSYCH AND DEV EVAL BY SPAT 6 6 8.233334 $617.5100 $75.0000
IPDEF -T1024GNTSGT F/U PHYC AND DEV EVAL BY SPAT 5 5 6.188889 $464.1700 $75.0000
IPDEF -T1024GPTS F/U PSYCH AND DEV EVAL BY PT 3 3 6.000000 $450.0000 $75.0000
IPDEF -T1024GPTSGT F/U PHYC AND DEV EVAL BY PT 3 3 2.016590 $151.2500 $75.0000
IPDEF -T1024TS F/U PSYCH AND DEV EVAL BY ITDS 14 14 26.116667 $1449.4800 $55.5000
IPDEF -T1024TSGT F/U PHYC AND DEV EVAL BY ITDS 4 4 6.005479 $333.3100 $55.5000
IPDEI -T1024GNUK INITIAL PSYCH AND DEV EVAL BY SPAT 19 19 38.000000 $2850.0000 $75.0000
IPDEI -T1024GNUKGT INITIAL PSYCH AND DEV EVAL BY SPAT 29 29 50.060275 $3754.5200 $75.0000
IPDEI -T1024GOUK INITIAL PSYCH AND DEV EVAL BY OT 13 13 26.966667 $2022.5000 $75.0000
IPDEI -T1024GPUK INITIAL PSYCH AND DEV EVAL BY PT 7 7 14.966667 $1122.5000 $75.0000
IPDEI -T1024GPUKGT INITIAL PSYCH AND DEV EVAL BY PT 23 23 40.008220 $3000.6100 $75.0000
IPDEI -T1024HNUK INITIAL PSYCH AND DEV EVAL BY ITDS 28 28 54.000000 $2997.0000 $55.5000
IPDEI -T1024HNUKGT INITIAL PSYCH AND DEV EVAL BY ITDS 30 30 48.085846 $2668.7600 $55.5000
NUTR -97803 NUTRITIONAL EVAL, FOLLOW-UP 1 1 0.716667 $35.8400 $50.0000
OCTH -97165 OT EVAL LOW COMPLEXITY 1 1 1.000000 $51.0500 $51.0500
OCTH -97167 OT EVAL HIGH COMPLEXITY 3 3 2.246575 $114.6900 $51.0500
SPCH -92523 EVAL OF SPCH SOUND PROD; EVAL LANG 1 1 0.427778 $21.8400 $51.0500
SPCH -92524 BEHAV & QUAL ANALYSIS OF VOICE AND 1 1 1.000000 $51.0500 $51.0500
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Subtotal (Total Children Is Unduplicated) 109 192 334.039654 $22256.0500 $66.6300
EI Services, Class # 03
COIFF -COIFF IFSP CONSULT, PROF, FACE TO FACE 41 46 43.427777 $2171.3900 $50.0000
COIFF -COIFFGT IFSP CONSULT,PROF,FACE TO FACE 15 17 13.000000 $650.0000 $50.0000
COIFP -COIFP IFSP CONSULT, PROF, BY PHONE 3 3 3.000000 $75.0000 $25.0000
CONIF -CONIF CONSULT, ITDS FACE TO FACE 258 273 345.762696 $17288.1100 $50.0000
CONIF -CONIFGT CONSULT,ITDS,FACE TO FACE 47 47 80.391271 $4019.5700 $50.0000
CONOF -CONOF CONSULT, OT, FACE TO FACE 121 129 171.368651 $8568.4300 $50.0000
CONOF -CONOFGT CONSULT,OT,FACE TO FACE 30 30 63.588096 $3179.4200 $50.0000
CONOP -CONOP CONSULT, OT, PHONE 3 3 1.377777 $34.4400 $25.0000
CONPF -CONPF CONSULT, PT, FACE TO FACE 89 91 95.380556 $4769.0300 $50.0000
CONPF -CONPFGT CONSULT,PT,FACE TO FACE 22 23 28.445236 $1422.2600 $50.0000
CONPP -CONPP CONSULT, PT, PHONE 2 2 1.800000 $45.0000 $25.0000
CONSF -CONSF CONSULT, SLP, FACE TO FACE 192 205 230.997990 $11549.9100 $50.0000
CONSF -CONSFGT CONSULT,SLP,FACE TO FACE 60 63 87.171426 $4358.5600 $50.0000
CONSP -CONSP CONSULT, SLP, PHONE 2 2 0.300000 $7.5000 $25.0000
EIIF -T1027SC EI INDIVIDUAL SESSION BY EI PROF 79 84 459.259525 $22962.9900 $50.0000
EIIF -T1027SCGT EI INDIVIDUAL SESSION BY EI PROF 11 11 78.750000 $3937.5100 $50.0000
INTR -T1013 INTERPRETER 1 1 2.000000 $100.0000 $50.0000
OCCT -97530 OT SESSION BY LICENSED OT 2 2 12.714285 $908.3100 $71.4400
PHY -97110 PT SESSION BY LICENSED PT 5 5 16.428572 $1173.6400 $71.4400
SPL -92507 SPL THERAPY SESSION BY LICENSED SLP 2 2 7.214286 $515.3900 $71.4400
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Subtotal (Total Children Is Unduplicated) 358 1039 1742.378144 $87736.4300 $50.3500
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Total 1248 2096.506687 $109992.4700 $52.4600
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Number of Children (Unduplicated) With at Least One Authorization 456